Fraud Crackdown Nets $4 Billion

It is no secret that tens of billions of dollars are lost annually to Medicare and Medicaid fraud -- as much as $100 billion total. Indeed, when it comes to the fabled problem of "waste, fraud, and abuse," the healthcare sector leads the way and this is an area where the government can save a boatload of money through greater enforcement efforts.

The potential scope of savings was demonstrated over the past year, when the government pulled in an impressive $4 billion in recovered money from healthcare fraudsters -- the highest amount ever over a 12-month period.

The money is rolling in, along with indictments, thanks to far-reaching cooperation between the Health and Human Services Department and the Justice Department, along with Treasury. In 2009, the Obama Administration created the Health Care Fraud Prevention & Enforcement Action Team (HEAT) "to prevent waste, fraud and abuse in the Medicare and Medicaid programs and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars." There is also a Health Care Fraud and Abuse Control Program (HCFAC) and Medicare Fraud Strike Force that has been ramped up to operate in growing number of cities.

The scope and variation of the healthcare frauds that the feds are going after is breathtaking, and laid in detail in document below. And the sheer number of individuals nailed is shocking. As the government reported,

Strike Force enforcement accomplishments in all seven cities during FY 2010 include:

• 140 indictments involving charges filed against 284 defendants who collectively billed the Medicare program more than $590 million;
• 217 guilty pleas negotiated and 19 jury trials litigated, winning guilty verdicts against 23 defendants; and
• Imprisonment for 146 defendants sentenced during the fiscal year, averaging more than 40 months of incarceration.

Including Strike Force matters, federal prosecutors opened 1,116 criminal health care fraud investigations as of the end of FY 2010, and filed criminal charges in 488 cases involving 931 defendants. A total of 726 defendants were convicted for health care fraud-related crimes during the year.

Medicare Fraud Report